<div id=tiga_ba>
	<div id=tiga_baa>Tambah Kabupaten</div>
	<div id=tiga_bab></div>
	<div class=clear></div>
</div>
            
<form action="utama.php?module=mod_kabupaten&act=simpan" onsubmit="return gsValidate('kode|kabupaten','Kode Kabupaten Harus Diisi|Nama Kabupaten Harus Diisi','required_numeric|required');" method="post" enctype="multipart/form-data">
	<table style="margin: 10px 15px 10px 15px;">
		<tr>
			<td>Kode Kabupaten</td>
			<td>
				<input name="kode" type="text" id="kode" class="input_small" />
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td>Nama Kabupaten</td>
			<td>
				<input name="kabupaten" type="text" class="input2" id="kabupaten" maxlength="50" />
				<span class="red">*</span>
			</td>
		</tr>
		<tr>
			<td>Provinsi</td>
			<td>
				<select name="provinsi" id="provinsi" class="input2">
					<?php
						$provinsi = mysql_query("select * from propinsi where aktif = 'Y' order by propinsi");
						while($p = mysql_fetch_array($provinsi)){
							if($p['id_propinsi']=='64'){
								$s = "selected";
							}else{
								$s = "";
							}
							echo "<option value='$p[id_propinsi]' $s>$p[propinsi]</option>";
						}
					?>
				</select>
			</td>
		</tr>
		<tr>
			<td>Status</td>
			<td>
				<input type='radio' name='status' value='Y' >Aktif
				<input type='radio' name='status' value='N' checked>Tidak Aktif
			</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td><input name="submit" type="submit" class="button" value="Simpan" /></td>
		</tr>
	</table>                
</form>		
            
        